title: Blood pressure control in a hypertension telemedicine intervention: does distance to primary care matter?
abstract: Although telemedicine may help overcome geographic access barriers, it is unknown whether rural patients receive greater benefits. In a secondary analysis of 503 veterans participating in a hypertension telemedicine study, the authors hypothesized that patients with greater travel distances would have greater improvements in 18-month systolic blood pressure (SBP). Patients were categorized by telemedicine exposure and travel distance to primary care, derived from zip codes. Comparisons were (1) usual care (UC), distance <30 miles (reference); (2) UC, distance ≥30 miles; (3) telemedicine, distance <30 miles; (4) telemedicine, distance ≥30 miles. Compared with patients receiving UC, distance <30 miles (intercept=127.7), no difference in 18-month SBP was observed in patients receiving UC, distance ≥30 miles (0.13 mm Hg, 95% confidence interval [-6.6 to 6.8]); telemedicine, distance <30 miles (-1.1 mm Hg [-7.3 to 5.2]); telemedicine, distance ≥30 miles (-0.80 mm Hg [-6.6 to 5.1]). Although telemedicine may help overcome geographic access barriers, additional studies are needed to identify patients most likely to benefit.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX; Division of Outcomes and Health Services Research, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowen
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017216:Telemedicine; D016896:Treatment Outcome; D014481:United States; D014728:Veterans